When do you stop feeling sick during pregnancy

This guide was originally published on May 14, 2019 in NYT Parenting.

The term “morning sickness” is an unfortunate misnomer. The awful nausea and vomiting that many pregnant women experience can strike any time of the day —morning, afternoon or night. It can make you miserable and, if severe enough, can seriously interrupt your daily life.

The good news: experts say there are practical steps you can take to help find relief, from home treatments to prescription medications. While it may be difficult to get rid of all symptoms, “this is a treatable condition and we can break the cycle and get people feeling better,” said Dr. Sumona Saha, M.D., an associate professor of medicine at the University of Wisconsin School of Medicine and Public Health.

For this guide, I spoke with Dr. Saha as well as two obstetrician-gynecologists, and read scientific studies to discover the best strategies for treating nausea and vomiting during pregnancy.

What to Do

• Learn who gets morning sickness and when it hits.
• Understand what morning sickness feels like.
• Experiment with home strategies.
• Talk to your doctor about medication.
• Try alternative tools like meditation or massage to cope with symptoms.
• Make sure you have emotional support.
• When to Worry

Learn who gets morning sickness and when it hits.

Unfortunately, nausea and vomiting during pregnancy are quite common; morning sickness affects somewhere around three-quarters of pregnant women. While some women are more likely to get it due to family history and other factors, scientists still haven’t pinned down its exact cause, though many experts think that it is connected to hormonal changes during pregnancy. One major pregnancy hormone in particular, called human chorionic gonadotropin (hCG), is widely thought to be the primary culprit — women with higher levels of this hormone are more likely to get morning sickness (some studies support the hGC hypothesis, but researchers have also found conflicting evidence).

According to experts, the most important risk factors for morning sickness include:

• If you are pregnant with twins, triplets, etc. (pregnancy with multiples)

• If you had morning sickness during a previous pregnancy

• If other women in your family had morning sickness

• If you have a history of nausea and vomiting prior to pregnancy

Morning sickness usually starts early in a woman’s pregnancy, within the first nine weeks for almost everyone. Symptoms tend to peak around 10 weeks, and then usually subside by 14 to 16 weeks. For some women, nausea and vomiting might continue past that time. The timing is extremely variable, said Dr. Robert Silver, M.D., professor and chairman of obstetrics and gynecology at the University of Utah. However, if nausea and vomiting begin after nine weeks of pregnancy, let your doctor know so that she can consider other possible medical conditions.

Understand what morning sickness feels like.

The symptoms of morning sickness are, of course, nausea and vomiting. Experts say that while nausea can last all day, it is not expected that women will vomit throughout the day. They also note that mothers should be able to keep down at least some food and liquids. There are other potential effects of morning sickness — for instance, you may feel worse when in motion (such as in a car or on a bus) and strong odors may bother you.

In addition to its physical impact, morning sickness can take an economic and emotional toll. Women may have to miss work or might be less functional due to their symptoms, whether at the office or at home taking care of others. Some may feel isolated if their symptoms are so extreme that they can’t leave the house. They may also have to contend with the medical costs of doctor’s visits and medications.

Morning sickness has a silver lining though: researchers have found that mild nausea and vomiting are associated with better pregnancy outcomes. Moderate morning sickness, it appears, may have a protective effect.

Experiment with home strategies.

If you have morning sickness, don’t feel that you just have to suffer through it. But experts say that you might need to try different strategies before you find one that works. Keep in mind that unless your symptoms are severe, you likely don’t need to be concerned. “I think the biggest myth is that if you don’t eat 2,000 calories a day, your baby is going to be harmed,” explained Dr. Silver. “Having moms not worry as much about that is probably the single most helpful thing” to know.

For mild morning sickness that isn’t significantly affecting your quality of life, experts recommend first trying home treatments, such as:

• Eating a bland diet. Foods that are higher in protein and carbohydrates and lower in fat are often better tolerated, said Dr. Hyagriv Simhan, M.D., professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine. Try the BRAT diet (bananas, rice, applesauce, toast).

• Eating small, frequent meals throughout the day. Experts recommend six snack-type meals spread out over the day, rather than three big meals. Dr. Saha also advised eating solid foods and drinking liquids at different times. “Don’t sit down to eat a sandwich and a big glass of milk,” she said. “Focus on one thing, then try to get your liquids in.”

• Eating too much can make symptoms worse, but so can eating too little. An empty stomach can actually aggravate nausea. Try to at least eat something small, if you can. “If carbohydrates like crackers are all you can tolerate, then that’s actually a reasonable goal,” said Dr. Saha.

• Avoid too much movement on an empty stomach. The American College of Obstetricians and Gynecologists’ website recommends eating crackers or toast in bed before you get up in the morning, so that you don’t move around on an empty stomach.

• Pay attention to your aversions, and avoid triggers. Spicy foods as well as strong odors like perfumes, chemical cleaners and smoke are common nausea triggers.

• Try using ginger, whichever form you find most tolerable. That might be ginger tea, ginger lollipops or candies, or ginger capsules. “Ginger actually has some fairly good data behind it to support its use,” noted Dr. Saha.

• Stay hydrated. If the smell of liquids nauseates you, try putting the beverage on ice, putting a cover over it, and drinking it through a straw.

• Take prenatal vitamins anytime. “The time of the day you take a prenatal vitamin does not matter, so take it when you can — with or without food, whatever works for you. Chewable vitamins if that’s better,” said Dr. Simhan.

• Acupressure may be helpful. Some women say that acupressure helps their nausea and vomiting in pregnancy, while others report that it does not. Some studies have looked into its use for morning sickness, but experts say the jury is still out on whether it works.

Talk to your doctor about medication.

Experts note that it’s difficult to give specific criteria for exactly when a woman might want to try medications rather than just using home treatments. If your morning sickness is severe enough that you’re losing weight, you’re dehydrated or you have other concerning symptoms, you should definitely speak with your provider.

But if you try lifestyle and diet changes and you still feel like you need additional relief, that’s also a valid reason for using medication. “It doesn’t require malnutrition or dehydration to justify medications,” said Dr. Simhan. Nearly all morning sickness meds require a prescription, and regardless of what you take, you should talk with your doctor first. Here are some of the options they might discuss with you:

• Diclegis - This is the only Food and Drug Administration-approved prescription drug for nausea and vomiting in pregnancy. Its most common side effect is drowsiness. Diclegis is actually a combination of vitamin B6 and the antihistamine doxylamine (found in the over-the-counter sleep aid, Unisom SleepTabs). It’s possible to buy vitamin B6 and Unisom and take them together without a prescription, but make sure to speak with your doctor first.

• Other medications, such as Zofran, Phenergan, Compazine and Reglan, are commonly prescribed off-label in the United States for nausea and vomiting in pregnancy. These medications all have potential side effects, which you should discuss with your provider.

Try alternative tools like meditation or massage to cope with symptoms.

If you are having trouble coping with your morning sickness, whether you’re taking medication or not, it might be worth adding in alternatives. Silver recommended approaches like meditation, exercise, deep-breathing, massage or even counseling. Treating nausea and vomiting in pregnancy “is a little bit like treating chronic pain,” explained Dr. Silver. You may not necessarily be nausea-free, but finding tools that help you function in daily life in spite of the pain “gets people through the day,” he said.

Make sure you have emotional support.

Many people fail to appreciate how awful and debilitating morning sickness can be. “Morning sickness has the connotation that ‘Oh, this is a normal part of pregnancy,’ and people don’t think of it as being pathology related to pregnancy,” said Dr. Saha. “A lot of women get undertreated or they don’t even seek medical advice for their condition.” That is a major problem. Make sure your family, your partner and your doctor give you with the emotional support you need, and let your provider know if you are struggling.

When to Worry

Up to 3 percent of pregnant women experience the most extreme form of nausea and vomiting during pregnancy, called hyperemesis gravidarum. H.G. may potentially cause complications for both the mother and her baby, and requires treatment. Watch for symptoms such as unrelenting vomiting, weight loss, decreased urination, dark colored urine, light-headedness or dizziness, and fainting or feeling like you’re going to pass out. Read more about hyperemesis gravidarum here.

It’s also important to remember that nausea and vomiting during pregnancy could be symptoms of another condition, not morning sickness. “Often, whenever a pregnant woman feels a symptom, it’s natural to attribute it to pregnancy,” explained Dr. Simhan. “But lots of other things can happen too, like viral illnesses, appendicitis, etc. All these things happen to people, whether or not they are pregnant.” He said that you should contact your provider if you are unable to keep food or drink down for 12 hours or more, have persistent vomiting, blood in your vomit, fever, jaundice, severe pain, diarrhea or other unusual symptoms.

[Pregnancy pains got you down? Read this.]

Annie Sneed is a science journalist who has written for Scientific American, Wired and Fast Company.